Treatment:
Phase 1 therapy, including oral hygiene instructions, scaling, and root planing was performed, and combination antibiotic therapy consisting of 500 mg amoxicillin and 500 mg metronidazole orally was administered three times a day for a week. During the reevaluation, a significant improvement in patients oral hygiene and bleeding index was noticed, however, with very little improvement distal to #16. Thus, periodontal surgical therapy was initiated after reevaluation. The patient underwent open flap debridement around teeth #26 and 46, connective tissue grafting around tooth #34, and anterior esthetic crown lengthening.
Tooth #16 was previously endodontically treated, and flap reflection revealed that the vertical defect involved more than two-thirds of the distal root with deep grade 2 furcation involvement. Therefore, distal root amputation was performed to maintain the tooth while eliminating the pocket and furcation area, rendering the area accessible for maintenance using oral hygiene measures. (Figure 2)
Subsequent prosthodontic evaluation revealed that the tooth was subjected to low occlusal forces, the access cavity was small with minimal loss of tooth structure, precluding the need for tooth crowning.